Pediatric Data, Assessment, and Prioritization of Interventions

Pediatric Data, Assessment, and Prioritization of Interventions

Goals that have been prioritized

Gabriel’s temperature must be reduced by 2 degrees Fahrenheit before he can be discharged home. Because Gabriel had a fever-induced seizure, this is the number one priority goal to reduce his chances of having another seizure. Some pharmacological nursing interventions to achieve this goal include administering Tylenol and Ibuprofen, as well as the antibiotic prescribed by the doctor to combat the ear infection that is causing the fever. Gabriel can quickly reduce the fever with medications, nonpharmacological fever, and decreasing measures such as sponge bathing with lukewarm water (Silbert-Flagg et al., 2017). If tepid sponging does not reduce Gabriel’s fever, the nurse may place a cold washcloth under his underarm or on his forehead (Silbert-Flagg et al., 2017).

Gabriel’s next priority is to begin and finish the full course of cefuroxime within ten days of starting therapy. This is the next priority because his ear infection caused his fever and, as a result, the seizure that resulted in his broken arm and ER visit, and taking antibiotics as prescribed is required to ensure the infection is cured. Nursing interventions that can help meet this goal include educating Gabriel’s mother on the importance of finishing the entire course of antibiotics, regardless of whether his fever has gone down and he is feeling better. Instruct his mother that this medication can be administered with or without food but that taking it with food may help reduce gastrointestinal upset and that the tablets should be swallowed whole (Vallerand & Sanoski, 2019). After the first dose of antibiotic is administered, the nurse can assess for any signs of an allergic reaction and teach Gabriel and his mother about symptoms to watch for after discharge. This is necessary so that the cefuroxime can be stopped and a different antibiotic can be started right away to ensure that the ear infection is cured as soon as possible.

The final priority goal is to ensure that Gabriel’s pain level does not exceed a 4/10 before he is discharged home. While pain management is critical, it is not the highest priority because his pain does not put him at risk for seizures or further injury. To achieve the first two priority goals, two nursing interventions for pain management have already been implemented. Because Gabriel has two potential sources of pain, his ear infection and his right ulnar fracture, administering Tylenol and Ibuprofen to reduce fever will also help to address both sources of pain, as well as administering antibiotics to help with the ear infection, which can cause pain. To assess the effectiveness of Tylenol and Ibuprofen, a pain assessment should be completed within 30-45 minutes of their administration. The nurse can also use a sling to help stabilize the arm and reduce limb movement, which can aggravate pain (Rebar et al., 2017).

Medication Dosages Exact

It is critical that your child receives the correct dose of each medication. Gabriel’s adverse effects can be reduced by administering the exact amount and precisely as prescribed. It is critical to administer the correct dose to avoid the medication’s toxic effects. Notify Gabriel’s doctor immediately if symptoms of an allergic reaction or superinfection appear (fuzzy overgrowth on the tongue or loose stool with a foul odor) (Vallerand & Sanoski, 2019). The table below breaks down the exact dosages of each medication that you should give to Gabriel: Acetaminophen: (Antipyretic) – ORDER: 15 mg/kg PO Q4 hours PRN for up to 3 days of fever or pain.

Because Gabriel weighs 21.8kg, each dose of acetaminophen will contain 327mg. Based on the milligrams (mg) concentration in each 5mL, the following is the exact amount to administer:

If the vial contains 125mg/5mL, you will administer 13.1mL per dose to Gabriel.

You will give Gabriel the following if the vial contains 250mg/5mL: Ibuprofen 6.5mL per dose: (Nonsteroidal Anti-Inflammatory Medication) – ORDER: 10 mg/kg PO Q6 hours PRN for up to 3 days of fever and pain.

Because Gabriel weighs 21.8kg, each dose of acetaminophen will contain 218mg. Based on the milligrams (mg) concentration in each 5mL, the following is the exact amount to administer:

If the vial contains 125mg/5mL, you will administer 8.7mL per dose to Gabriel.

If the vial contains 250mg/5mL, you will administer 4.4mL per dose to Gabriel.

ORDER: 30mg/kg PO BID for ten days, not to exceed 1,000mg daily.

Gabriel’s calculated daily dose is 1,308mg due to his weight of 21.8kg. His order, however, states that he must not exceed 1,000mg per day. This means that in order to stay within the daily limit, he will need to take 500mg twice a day. This medication is available in liquid form in 5mL increments of 125mg or 250mg. Based on the milligrams (mg) concentration in each 5mL, the following is the exact amount to administer:

You will give Gabriel 20mL per dose if the vial contains 125mg/5mL.

If the vial contains 250mg/5mL, you will administer 10mL per dose to Gabriel.

References

Rebar, C., Ignatavicius, D., Workman, M. L. (102017). Medical-Surgical Nursing, 9th Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9780323461580

Silbert-Flagg, J., Pillitteri, A. (2017). Maternal and Child Health Nursing, 8th Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9781496374578

Vallerand, A., & Sanoski, C. (2019). Davis’s Drug Guide for Nurses: Vol. 16th ed. F.A. Davis Company.

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Purpose

The nursing student should be able to identify seizure activity, educate the family and/or caregiver of the pediatric patient on what to do if a seizure occurs what medications to administer, and implement safety to prevent injury and treat fracture. The student should also develop education to support discharge based on an assessment of data.

Competency

Prioritize nursing interventions when caring for pediatric clients with health disorders.

Scenario

A 5-year-old Gabriel, a multiracial male weighing 48 lbs with an allergy to penicillin, arrives in the emergency room; no cultural considerations were identified. You are handed the following notes on the patient that read:

He arrived in the ER with his mother after falling out of bed after jerking movement activity, as witnessed by his older brother while sleeping. Right upper extremity appears with deformity. Mother and child speak English. The child has no significant medical history. The mother reports incontinent of urine during the episode.

Your Assessment

Vital Signs: T 102.9, P 135, R 24, BP 118/60, O2 sat 100% RA

General Appearance: appears drowsy; face flushed, quiet

Neuro: oriented X3

Cardiovascular: unremarkable

Respiratory: lungs clear

Integumentary: very warm, dry

GI/GU: abdomen normal

Physician Orders

• Complete Blood Count (CBC)
• Complete Metabolic Panel (CMP)
• Urinalysis with culture and sensitivity (U/A C&S)
• Blood Cultures x 2
• X-rays kidneys,
• Influenza screening
• Acetaminophen 15 mg/kg PO now
• Ibuprofen 10 mg/kg PO now
• Pad side rails
• Suction at the bedside with seizure precautions
• Radiographs of the right arm
• Cast to right arm
• Start PO fluids and increase as tolerated

The physician discharges Gabriel from the ER to home with a diagnosis of Right ear infection, Acute Febrile Seizure, and fracture of the right ulna.

Discharge orders include:

• Follow up with pediatrician in 7 days
• Follow up with pediatric orthopedics in 7-10 days
• Cefuroxime 30mg/kg PO BID for 10 days, not to exceed 1,000mg daily. What is the recommended dosage if cefuroxime is supplied as an oral suspension, 125mg/5ml or 250mg/5ml?
• Acetaminophen 15 mg/kg PO Q4 hours PRN fever or pain and ibuprofen 10 mg/kg PO Q6 hours PRN fever and pain for up to 3 days
• Acetaminophen is available as 160 mg/5 mL. Ibuprofen is available as 100 mg/ 5 mL.
• What is the amount of acetaminophen in mg and ml per dose? What is the amount of ibuprofen in mg and ml per dose?

Instructions

Develop a discharge plan with three goals listed in order of priority prior to discharge from current orders. Provide a rationale for why you listed the goals in a particular order. Also, list three nursing interventions to meet each of the goals (you should have nine interventions in total). Last, the mother should give the child the exact dosage she will need to give for acetaminophen, ibuprofen, and cefuroxime when she gets home and explain why the exact dosage is important.